Abstract 3476: Pentraxin 3 is a Clinically Significant Cardiac Inflammatory Marker Associated With Left Ventricular Diastolic Dysfunction
Background: Pentraxin 3 (PTX3) is a newly identified pentraxin superfamily member including C-reactive protein (CRP) and rapidly increased by inflammatory stimuli. The relationship between PTX3 levels and diastolic heart failure (DHF) has been unknown. We investigated clinical significance of PTX3 levels in patients with DHF and whether PTX3 is produced from coronary circulation in patients with left ventricular (LV) diastolic dysfunction.
Methods: We measured plasma levels of PTX3, high-sensitivity CRP (hsCRP) and B-type natriuretic peptide (BNP) in 228 patients, 87 DHF patients (LV ejection fraction [LVEF]>50%, E/e′>12 or E/A<0.8: age 70.8±10.1, male 62.1%) and 70 systolic heart failure patients (SHF: LVEF≤50%: age 65.5±13.6, male 69.5%) and 171 control subjects (age 66.6±11.2, male 56.1%) with or without LV diastolic dysfunction (LVDD: E/e′>12 or E/A<0.8). We measured PTX3 levels at aortic root (Ao) and coronary sinus (CS) in 75 consecutive patients who received coronary angiography.
Results: Peripheral plasma levels of PTX3 and BNP, but not hsCRP, were significantly higher in DHF patients than controls (PTX3; 3.26 [2.23– 4.36] vs. 2.19 [1.52–2.91]ng/ml, p<0.001, BNP; 88.6 [34.2–219.5] vs. 27.1 [13.2–50.5]pg/ml, p<0.01, HsCRP; 0.90 [0.33–1.60] vs. 0.70 [0.30 –1.30]mg/l, p=0.14). PTX3 levels at CS were significantly higher than those at Ao in patients with SHF (CS; 3.45 [2.64 –5.25], Ao; 3.31 [2.41–5.18], p<0.01), DHF (CS; 3.29 [2.78 – 4.24], Ao; 3.02 [2.52– 4.29], p=0.02) and in controls with LVDD (CS; 2.44 [1.90 –3.08], Ao; 2.33 [1.75–2.90], p=0.01), but not significantly different in controls without LVDD (CS; 1.86 [1.67–2.78], Ao; 1.96 [1.55–2.84], p=0.33). Multiple logistic regression analysis demonstrated that the higher levels of PTX3, but not hsCRP, were significantly and independently contributed to DHF (odds ratio 2.17, 95% confidence interval 1.23–3.63, p<0.01).
Conclusions: PTX3 is significantly elevated in patients with DHF and produced in the coronary circulation not only in patients with heart failure (HF) but also in non-HF patients with LVDD. Increased cardiac inflammatory status can be evaluated by PTX3 even in patients with LVDD. PTX3, but not hsCRP, is a clinically useful inflammatory marker for patients with DHF.